CPC SIU: Medical & Behavioral Health Coding Analyst

Voices for Voices; Trenton (NJ); Hybrid; USD 44,000 - 94,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Wellness programs

Retirement plan

Job summary

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. You will determine correct coding and documentation, ensuring compliance with state and federal guidelines while detecting billing irregularities.

You will review CPT/HCPCS/Revenue codes, prepare written summaries, and explain findings to investigators and leadership. The role requires up-to-date coding knowledge and travel flexibility as needed.

Qualifications

• AAPC CPC certification required.
• Minimum of 3 years in medical/behavioral health coding with 1–2 years of current professional coding experience.
• Knowledge of CPT, HCPCS, and Revenue Codes.
• CMS 1500 and UB04 data elements.
• Ability to interpret and apply established coding policies.
• Experience with Excel and Word.
• Ability to travel if needed.

Responsibilities

• Conduct comprehensive medical record reviews to ensure CPT/HCPCS/Revenue codes align with documentation.
• Provide detailed written summaries of review findings.
• Articulate findings to investigators, leadership, and regulators.
• Research state or CMS guidelines relevant to reviews.
• Review cases with Medical Directors to validate decisions.
• Assist with investigative coding research and policy reviews.
• Identify potential billing errors, abuse, and fraud.
• Identify savings opportunities warranting prepayment review.
• Maintain organized records and documentation.
• Follow workflows to meet performance metrics.

Skills

CPC certification

Medical coding experience

CPT knowledge

HCPCS knowledge

Education

AAPC CPC certification

GED or High School diploma

Tools

Microsoft Excel

Microsoft Word

Job description

CVS Health is seeking a Certified Professional Coder (CPC) to perform medical claim reviews for the Special Investigations Unit. You will determine correct coding and documentation, ensuring compliance with state and federal guidelines while detecting billing irregularities.

You will review CPT/HCPCS/Revenue codes, prepare written summaries, and explain findings to investigators and leadership. The role requires up-to-date coding knowledge and travel flexibility as needed.